Impediments to Adequate Nutrition
For patients at the end of life, the goals of nutrition therapy are directed at alleviating symptoms rather than reversing nutrition deficits. Recommendations support the use of safe food handling procedures and avoiding consumption of foods that pose a high risk of infection, as noted in Table 7. In addition, available data do not support the use of antioxidant supplements for CVD risk reduction Learners must earn at least a B grade on the creative component to graduate. Most plants, therefore, require nitrogen compounds to be present in the soil in which they grow. Jennifer Ashton breaks down why you should try this wellness challenge. These documents request licensees share information that may be used to commit fraud against a licensee or patient.
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For patients with diabetes at risk for CVD, diets high in fruits, vegetables, whole grains, and nuts may reduce the risk. In normotensive and hypertensive individuals, a reduced sodium intake e.
In most individuals, a modest amount of weight loss beneficially affects blood pressure. In the EDIC Epidemiology of Diabetes Interventions and Complications study, the follow-up of the DCCT Diabetes Control and Complications Trial , intensive treatment of type 1 diabetic subjects during the DCCT study period improved glycemic control and significantly reduced the risk of the combined end point of cardiovascular death, myocardial infarction, and stroke Adjustment for A1C explained most of the treatment effect.
The risk reductions obtained with improved glycemia exceeded those that have been demonstrated for other interventions such as cholesterol and blood pressure reductions. There are no large-scale randomized trials to guide MNT recommendations for CVD risk reduction in individuals with type 2 diabetes.
However, because CVD risk factors are similar in individuals with and without diabetes, benefits observed in nutrition studies in the general population are probably applicable to individuals with diabetes. The previous section on dietary fat addresses the need to reduce intake of saturated and trans fatty acids and cholesterol. Hypertension, which is predictive of progression of micro- as well as macrovascular complications of diabetes, can be prevented and managed with interventions including weight loss, physical activity, moderation of alcohol intake, and diets such as DASH Dietary Approaches to Stop Hypertension.
The DASH diet emphasized fruits, vegetables, and low-fat dairy products; included whole grains, poultry, fish, and nuts; and was reduced in fats, red meat, sweets, and sugar-containing beverages 7 , , The effects of lifestyle interventions on hypertension appear to be additive. Reduction in blood pressure in people with diabetes can occur with a modest amount of weight loss, although there is great variability in response 1 , 7. Regular aerobic physical activity, such as brisk walking, has an antihypertensive effect 7.
Although chronic excessive alcohol intake is associated with an increased risk of hypertension, light to moderate alcohol consumption is associated with reductions in blood pressure 7. Heart failure and peripheral vascular disease are common in individuals with diabetes, but little is known about the role of MNT in treating these complications. Alcohol intake is discouraged in patients at high risk for heart failure. Ingestion of 15—20 g glucose is the preferred treatment for hypoglycemia, although any form of carbohydrate that contains glucose may be used.
In individuals taking insulin or insulin secretagogues, changes in food intake, physical activity, and medication can contribute to the development of hypoglycemia. The acute glycemic response correlates better with the glucose content than with the carbohydrate content of the food 1. Although pure glucose may be the preferred treatment, any form of carbohydrate that contains glucose will raise blood glucose Adding protein to carbohydrate does not affect the glycemic response and does not prevent subsequent hypoglycemia.
Adding fat, however, may retard and then prolong the acute glycemic response. During hypoglycemia, gastric-emptying rates are twice as fast as during euglycemia and are similar for liquid and solid foods. During acute illnesses, insulin and oral glucose-lowering medications should be continued. During acute illnesses, testing of plasma glucose and ketones, drinking adequate amounts of fluids, and ingesting carbohydrate are all important. Acute illnesses can lead to the development of hyperglycemia and, in individuals with type 1 diabetes, ketoacidosis.
During acute illnesses, with the usual accompanying increases in counterregulatory hormones, the need for insulin and oral glucose-lowering medications continues and often is increased.
In adults, ingestion of — g carbohydrate daily 45—50 g every 3—4 h should be sufficient to prevent starvation ketosis 1. Establishing an interdisciplinary team, implementation of MNT, and timely diabetes-specific discharge planning improves the care of patients with diabetes during and after hospitalizations. Hospitals should consider implementing a diabetes meal-planning system that provides consistency in the carbohydrate content of specific meals.
Hyperglycemia in hospitalized patients is common and represents an important marker of poor clinical outcome and mortality in both patients with and without diabetes Optimizing glucose control in these patients is associated with better outcomes An interdisciplinary team is needed to integrate MNT into the overall management plan , Diabetes nutrition self-management education, although potentially initiated in the hospital, is usually best provided in an outpatient or home setting where the individual with diabetes is better able to focus on learning needs , There is no single meal planning system that is ideal for hospitalized patients.
However, it is suggested that hospitals consider implementing a consistent-carbohydrate diabetes meal-planning system , This systems uses meal plans without a specific calorie level but consistency in the carbohydrate content of meals. The carbohydrate contents of breakfast, lunch, dinner, and snacks may vary, but the day-to-day carbohydrate content of specific meals and snacks is kept constant , Special nutrition issues include liquid diets, surgical diets, catabolic illnesses, and enteral or parenteral nutrition , Liquids should not be sugar free.
Patients require carbohydrate and calories, and sugar-free liquids do not meet these nutritional needs. Care must be taken not to overfeed patients because this can exacerbate hyperglycemia. After surgery, food intake should be initiated as quickly as possible. Progression from clear liquids to full liquids to solid foods should be completed as rapidly as tolerated.
The imposition of dietary restrictions on elderly patients with diabetes in long-term care facilities is not warranted. Residents with diabetes should be served a regular menu, with consistency in the amount and timing of carbohydrate.
An interdisciplinary team approach is necessary to integrate MNT for patients with diabetes into overall management. In the institutionalized elderly, undernutrition is likely and caution should be exercised when prescribing weight loss diets. Although the prevalence of undiagnosed diabetes in elderly nursing home residents is high, not all of such individuals require pharmacologic therapy , Older residents with diabetes in nursing homes tend to be underweight rather than overweight Low body weight has been associated with greater morbidity and mortality in this population , Experience has shown that residents eat better when they are given less restrictive diets , Specialized diabetic diets do not appear to be superior to standard diets in such settings , Meal plans such as no concentrated sweets, no sugar added, low sugar, and liberal diabetic diet also are no longer appropriate.
These diets do not reflect current diabetes nutrition recommendations and unnecessarily restrict sucrose. These types of diets are more likely in long-term care facilities than acute care. Making medication changes to control glucose, lipids, and blood pressure rather than implementing food restrictions can reduce the risk of iatrogenic malnutrition.
The specific nutrition interventions recommended will depend on a variety of factors, including age, life expectancy, comorbidities, and patient preferences Major nutrition recommendations and interventions for diabetes are listed in Table 3.
Monitoring of metabolic parameters, including glucose, A1C, lipids, blood pressure, body weight, and renal function is essential to assess the need for changes in therapy and to ensure successful outcomes. Many aspects of MNT require additional research. Classification of overweight and obesity by BMI, waist circumference, and associated disease risk.
Mooradian, and Madelyn L. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Skip to main content. Diabetes Care Jan; 31 Supplement 1: This article has a correction. Errata - August 01, Department of Agriculture Medical nutrition therapy MNT is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications.
Goals of MNT that apply to individuals with diabetes Achieve and maintain Blood glucose levels in the normal range or as close to normal as is safely possible A lipid and lipoprotein profile that reduces the risk for vascular disease Blood pressure levels in the normal range or as close to normal as is safely possible To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle To address individual nutrition needs, taking into account personal and cultural preferences and willingness to change To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence Goals of MNT that apply to specific situations For youth with type 1 diabetes, youth with type 2 diabetes, pregnant and lactating women, and older adults with diabetes, to meet the nutritional needs of these unique times in the life cycle.
B Nutrition counseling should be sensitive to the personal needs, willingness to change, and ability to make changes of the individual with pre-diabetes or diabetes. A For weight loss, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short term up to 1 year. A For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake in those with nephropathy , and adjust hypoglycemic therapy as needed.
E Physical activity and behavior modification are important components of weight loss programs and are most helpful in maintenance of weight loss. B The importance of controlling body weight in reducing risks related to diabetes is of great importance. A Individuals at high risk for type 2 diabetes should be encouraged to achieve the U. B There is not sufficient, consistent information to conclude that low—glycemic load diets reduce the risk for diabetes.
E Observational studies report that moderate alcohol intake may reduce the risk for diabetes, but the data do not support recommending alcohol consumption to individuals at risk of diabetes. B No nutrition recommendation can be made for preventing type 1 diabetes.
E Although there are insufficient data at present to warrant any specific recommendations for prevention of type 2 diabetes in youth, it is reasonable to apply approaches demonstrated to be effective in adults, as long as nutritional needs for normal growth and development are maintained.
E The importance of preventing type 2 diabetes is highlighted by the substantial worldwide increase in the prevalence of diabetes in recent years. Diabetes in youth No nutrition recommendations can be made for the prevention of type 1 diabetes at this time 1. B Monitoring carbohydrate, whether by carbohydrate counting, exchanges, or experienced-based estimation remains a key strategy in achieving glycemic control.
A The use of glycemic index and load may provide a modest additional benefit over that observed when total carbohydrate is considered alone. B Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications. A As for the general population, people with diabetes are encouraged to consume a variety of fiber-containing foods.
B Sugar alcohols and nonnutritive sweeteners are safe when consumed within the daily intake levels established by the Food and Drug Administration FDA. A Control of blood glucose in an effort to achieve normal or near-normal levels is a primary goal of diabetes management.
Amount and type of carbohydrate. A Intake of trans fat should be minimized. E Two or more servings of fish per week with the exception of commercially fried fish filets provide n-3 polyunsaturated fatty acids and are recommended. B The primary goal with respect to dietary fat in individuals with diabetes is to limit saturated fatty acids, trans fatty acids, and cholesterol intakes so as to reduce risk for CVD. E In individuals with type 2 diabetes, ingested protein can increase insulin response without increasing plasma glucose concentrations.
A High-protein diets are not recommended as a method for weight loss at this time. Optimal mix of macronutrients Although numerous studies have attempted to identify the optimal mix of macronutrients for the diabetic diet, it is unlikely that one such combination of macronutrients exists. Alcohol in diabetes management Recommendations If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount one drink per day or less for women and two drinks per day or less for men.
E To reduce risk of nocturnal hypoglycemia in individuals using insulin or insulin secretagogues, alcohol should be consumed with food. E In individuals with diabetes, moderate alcohol consumption when ingested alone has no acute effect on glucose and insulin concentrations but carbohydrate coingested with alcohol as in a mixed drink may raise blood glucose.
B Abstention from alcohol should be advised for people with a history of alcohol abuse or dependence, women during pregnancy, and people with medical problems such as liver disease, pancreatitis, advanced neuropathy, or severe hypertriglyceridemia. Micronutrients in diabetes management Recommendations There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes compared with the general population who do not have underlying deficiencies.
A Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety. A Benefit from chromium supplementation in individuals with diabetes or obesity has not been clearly demonstrated and therefore can not be recommended.
E Uncontrolled diabetes is often associated with micronutrient deficiencies Antioxidants in diabetes management. Chromium, other minerals, and herbs in diabetes management. E Individuals using rapid-acting insulin by injection or an insulin pump should adjust the meal and snack insulin doses based on the carbohydrate content of the meals and snacks. A For individuals using fixed daily insulin doses, carbohydrate intake on a day-to-day basis should be kept consistent with respect to time and amount.
C For planned exercise, insulin doses can be adjusted. E The first nutrition priority for individuals requiring insulin therapy is to integrate an insulin regimen into their lifestyle.
Nutrition interventions for type 2 diabetes Recommendations Individuals with type 2 diabetes are encouraged to implement lifestyle modifications that reduce intakes of energy, saturated and trans fatty acids, cholesterol, and sodium and to increase physical activity in an effort to improve glycemia, dyslipidemia, and blood pressure. E Plasma glucose monitoring can be used to determine whether adjustments in foods and meals will be sufficient to achieve blood glucose goals or if medication s needs to be combined with MNT.
E Healthy lifestyle nutrition recommendations for the general public are also appropriate for individuals with type 2 diabetes. Nutrition interventions for pregnancy and lactation with diabetes Recommendations Adequate energy intake that provides appropriate weight gain is recommended during pregnancy. E Ketonemia from ketoacidosis or starvation ketosis should be avoided. E Because GDM is a risk factor for subsequent type 2 diabetes, after delivery, lifestyle modifications aimed at reducing weight and increasing physical activity are recommended.
A Prepregnancy MNT includes an individualized prenatal meal plan to optimize blood glucose control. Nutrition interventions for older adults with diabetes Recommendations Obese older adults with diabetes may benefit from modest energy restriction and an increase in physical activity; energy requirement may be less than for a younger individual of a similar weight.
E A daily multivitamin supplement may be appropriate, especially for those older adults with reduced energy intake. B MNT that favorably affects cardiovascular risk factors may also have a favorable effect on microvascular complications such as retinopathy and nephropathy.
C Progression of diabetes complications may be modified by improving glycemic control, lowering blood pressure, and, potentially, reducing protein intake. B For patients with diabetes at risk for CVD, diets high in fruits, vegetables, whole grains, and nuts may reduce the risk. C In normotensive and hypertensive individuals, a reduced sodium intake e. A In most individuals, a modest amount of weight loss beneficially affects blood pressure.
C In the EDIC Epidemiology of Diabetes Interventions and Complications study, the follow-up of the DCCT Diabetes Control and Complications Trial , intensive treatment of type 1 diabetic subjects during the DCCT study period improved glycemic control and significantly reduced the risk of the combined end point of cardiovascular death, myocardial infarction, and stroke B In individuals taking insulin or insulin secretagogues, changes in food intake, physical activity, and medication can contribute to the development of hypoglycemia.
Acute illness Recommendations During acute illnesses, insulin and oral glucose-lowering medications should be continued. A During acute illnesses, testing of plasma glucose and ketones, drinking adequate amounts of fluids, and ingesting carbohydrate are all important. B Acute illnesses can lead to the development of hyperglycemia and, in individuals with type 1 diabetes, ketoacidosis.
Patients with diabetes in acute health care facilities Recommendations Establishing an interdisciplinary team, implementation of MNT, and timely diabetes-specific discharge planning improves the care of patients with diabetes during and after hospitalizations.
E Hospitals should consider implementing a diabetes meal-planning system that provides consistency in the carbohydrate content of specific meals. E Hyperglycemia in hospitalized patients is common and represents an important marker of poor clinical outcome and mortality in both patients with and without diabetes Patients with diabetes in long-term care facilities Recommendations The imposition of dietary restrictions on elderly patients with diabetes in long-term care facilities is not warranted.
C An interdisciplinary team approach is necessary to integrate MNT for patients with diabetes into overall management. B Although the prevalence of undiagnosed diabetes in elderly nursing home residents is high, not all of such individuals require pharmacologic therapy , View inline View popup. Table 1— Nutrition and MNT. Table 2— Classification of overweight and obesity by BMI, waist circumference, and associated disease risk.
Table 3— Major nutrition recommendations and interventions. Footnotes Originally approved Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Nutrition principles and recommendations in diabetes Position Statement. Diabetes Care 27 Suppl. The evidence for the effectiveness of medical nutrition therapy in diabetes management.
How effective is medical nutrition therapy in diabetes care? J Am Diet Assoc Am J Clin Nutr When to start cholesterol-lowering therapy in patients with coronary heart disease: Whitworth JA, Chalmers J: Clin Exp Hypertens National Heart, Lung, and Blood Institute: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.
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Glycemic index of foods: Towards understanding of glycaemic index and glycaemic load in habitual diet: Br J Nutr Carbohydrates and increases in obesity: Obes Res 12 Suppl. Low-glycemic index diets in the management of diabetes: Improved plasma glucose control, whole-body glucose utilization, and lipid profile on a low-glycemic index diet in type 2 diabetic men: Sucrose compared with artificial sweeteners: Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus.
Effect of energy restriction, weight loss, and diet composition on plasma lipids and glucose in patients with type 2 diabetes. Effect of a high-protein, high—monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes.
Diet and risk of type II diabetes: Substituting dietary saturated fat with polyunsaturated fat changes abdominal fat distribution and improves insulin sensitivity.
Dietary fat intake and risk of type 2 diabetes in women. Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. Acute effects of monounsaturated fatty acids with and without omega-3 fatty acids on vascular reactivity in individuals with type 2 diabetes.
Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Fish intake and risk of incident heart failure. J Am Coll Cardiol Fish intake is associated with a reduced progression of coronary artery atherosclerosis in postmenopausal women with coronary artery disease.
A phytosterol-enriched spread improves the lipid profile of subjects with type 2 diabetes mellitus: Eur J Nutr Effect of protein ingestion on the glucose appearance rate in people with type 2 diabetes.
J Clin Endocrinol Metab Effects of oral hypoglycemic agents and diet on protein metabolism in type 2 diabetes. Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. The effect of evening alcohol consumption on next-morning glucose control in type 1 diabetes.
Micronutrients in diabetes mellitus. Drugs, Diet and Disease 2: Complementary therapies for diabetes: Arch Med Res The role of the optimal healing environment in the care of patients with diabetes mellitus type II. J Altern Complement Med 10 Suppl. Hasanain B, Mooradian AD: Antioxidant vitamins and their influence in diabetes mellitus. Curr Diab Rep 2: Effects of vitamin E on cardiovascular and microvascular outcomes in high-risk patients with diabetes: Antioxidant vitamin supplements and cardiovascular disease.
Selected vitamins and minerals in diabetes. Role of chromium in human health and in diabetes. Chromium as adjunctive treatment for type 2 diabetes. Glucose and insulin responses to dietary chromium supplements: Chromium supplementation does not improve glucose tolerance, insulin sensitivity, or lipid profile: Chromium treatment has no effect in patients with poorly controlled, insulin-treated type 2 diabetes in an obese Western population: Chromium picolinate for reducing body weight: Systematic review of herbs and dietary supplements for glycemic control in diabetes.
Clin Geriatr Med Effects of meal carbohydrate content on insulin requirements in type 1 diabetic patients treated intensively with the basal-bolus ultralente-regular insulin regimen. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen ultralente-lispro.
Wasserman DH, Zinman B: Exercise in individuals with IDDM. Care of children and adolescents with type 1 diabetes mellitus: Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.
Predictors of postpartum diabetes in women with gestational diabetes mellitus. Reader D, Franz MJ: Lactation, diabetes, and nutrition recommendations. Curr Diab Rep 4: Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc Nutrition education improves metabolic outcomes among older adults with diabetes mellitus: Management of obesity in the elderly: An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons.
Dietary variety predicts low body mass index and inadequate macronutrient and micronutrient intakes in community-dwelling older adults. Protein restriction, glomerular filtration rate and albuminuria in patients with type 2 diabetes mellitus: Eur J Clin Nutr Long-term effects of protein-restricted diet on albuminuria and renal function in IDDM patients without clinical nephropathy and hypertension. Effect of protein intake on glycaemic control and renal function in type 2 non-insulin-dependent diabetes mellitus.
Determination of optimal protein contents for a protein restriction diet in type 2 diabetic patients with microalbuminuria. Tohoku J Exp Med Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy.
Severe dietary protein restriction in overt diabetic nephropathy: J Ren Nutr Animal versus plant protein meals in individuals with type 2 diabetes and microalbuminuria: Main risk factors for nephropathy in type 2 diabetes mellitus are plasma cholesterol levels, mean blood pressure, and hyperglycemia.
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Endocrinol Metab Clin North Am Diabetes nutrition recommendations for health care institutions Position Statement. Management of diabetes and hyperglycemia in hospitals. Undiagnosed diabetes mellitus and metabolic control assessed by HbA 1c among residents of nursing homes. Exp Clin Endocrinol Diabetes Dietary management of nursing home residents with non-insulin-dependent diabetes mellitus.
The use of a no-concentrated-sweets diet in the management of type 2 diabetes in nursing homes. Management of diabetes mellitus in the nursing home. The Annals of Long Term Care 6: In this Issue January , 31 Supplement 1. Table of Contents Index by Author. Search for this keyword. Sign up to receive current issue alerts. View Selected Citations 0. Thank you for your interest in spreading the word about Diabetes Care. You are going to email the following Nutrition Recommendations and Interventions for Diabetes.
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